Masters of Science in Medicine / The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. Limited research into the relationship between COPD and swallow function suggests that patients with COPD are at increased risk of aspiration. One possible mechanism for this is a reduction in laryngopharyngeal sensitivity (LPS). Reduced laryngopharyngeal sensitivity (LPS) has been associated with an increased risk of aspiration in pathologies such as stroke, however impaired LPS has not been examined with respect to aspiration risk in COPD. The Aims of this study were to investigate the effect of COPD on laryngopharyngeal sensation using Laryngopharyngeal Sensory Discrimination Testing (LPSDT) and to determine whether a relationship between LPS and swallow function in patients with proven COPD exists. Method: 20 patients with proven COPD and 11 control subjects underwent LPSDT utilising an air-pulse stimulator (Pentax AP4000) via a nasendoscope (Pentax FNL10AP). The threshold of laryngopharyngeal sensation was measured by the air pressure required to elicit the laryngeal adductor reflex (LAR). A number of further examinations were also completed for COPD subjects. These included respiratory function testing, self-reporting questionnaire on swallowing ability (SSQ), bedside clinical examination of swallowing (MASA) and endoscopic assessment of swallowing (EAS). Results: subjects with COPD had a significantly higher LAR threshold when compared to their normal healthy counterparts (p<0.001). Positive correlations were identified for the relationships between MASA score and EAS results for presence of laryngeal penetration / aspiration (p<0.04), vallecular residue (p<0.01) and piriform residue (p<0.01). Conclusion: Patients with COPD have significantly reduced mechanosensitivity in the laryngopharynx. Patients with COPD also have impaired swallow function characterised primarily by pharyngeal stasis. These changes may place patients with COPD at increased risk of aspiration.

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Nursing. Bibliography: leaves 117-143. Also available online via the Internet.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 6 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Missouri-Columbia, 2005. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2005" Includes bibliographical references.

Introduction Chronic obstructive pulmonary disease (COPD) has emerged as a major policy focus for health systems throughout Western Europe. This reflects the increased prevalence, associated healthcare utilisation and costs of COPD, and the potential to substantially improve outcomes through achieving reductions in smoking. The aim of this PhD was to develop projections for the prevalence, healthcare costs and number of deaths in people with COPD in England and Scotland over a 20-year horizon (i.e. from 2011 to 2030). Methods I undertook a phased programme of work, which began with a systematic review of the published and unpublished literature to identify models that were suitable for estimating and/or projecting the prevalence and disease and economic burden from COPD. This involved searching Medline, Embase, CAB Abstracts, World Health Organization (WHO) Library and Information Services and WHO Regional Indexes, and Google over the time period 1980-2013. The models were then critically appraised for their quality of reporting. From these, I selected the Dutch Model developed by Erasmus University for generating projections. Suitable data sources from both England and Scotland were identified, sourced and carefully processed in order to run the modelling exercises. Rates of incidence and prevalence were calculated using English and Scottish healthcare datasets and population data were obtained from the Office for National Statistics (ONS) and the General Register Office for Scotland (GROS). Relative risks for all-cause mortality among people with COPD were calculated from the Clinical Practice Research Datalink and mortality data were obtained from the ONS and GROS. The Model was thus adjusted to apply to England and Scotland. I then travelled to the Netherlands to work with the developers of the Dutch Model and ran a baseline model and an array of sensitivity analyses with modified inputs to the Model. Finally, my Rotterdam colleagues calculated uncertainty intervals for some of the estimates using probabilistic analysis. Results Using the probabilistic means and uncertainty intervals, in England, the modelled prevalence of diagnosed COPD among males of all ages in 2011 was 1.8% (95% uncertainty interval 1.8-1.9) increasing to 2.0% (1.7-2.1) by 2030. In females, in England, the baseline estimate was 1.8% (1.7-1.8) in 2011 increasing to 2.4% (2.0-2.6) in 2030. In Scotland, the modelled prevalence among males was 1.9% (1.8-1.9) in 2011 and this was projected to stay the same at 1.9% (1.7-2.2) by 2030. In females in Scotland, the estimated prevalence was 2.2% (2.1- 2.3) in 2011 and was projected to increase to 2.5% (2.1-2.7) in 2030.Using the Model I estimated that overall in 2011 there were a total of 952,000 (941,000-966,000) people with diagnosed COPD in England and 106,000 (103,000-110,000) in Scotland and that these numbers would increase to 1,325,000 (1,117,000-1,408,000) in England in 2030 and 125,000 (113,000-136,000) in Scotland in 2030, respectively. The greatest increase in COPD was projected to be in females over 65 years of age in both countries. The total annual direct healthcare costs of COPD in England were projected to increase from £1.60 (95% uncertainty interval 1.18-2.5) billion in 2011 to £2.35 (1.85-3.08) billion in 2030. In Scotland, costs were projected to increase from £170 (128-268) million in 2011 to £210 (165-274) million in 2030. These costs were calculated in terms of 2011 costs without the application of any economic trends (i.e. no annual increase applied for inflation). The number of deaths among people with COPD in England was estimated to be 99,000 (93,000-129,000) in 2011, increasing to 129,000 (126,000-133,000) in 2030. In Scotland there were estimated to be 10,000 (9,000-12,000) deaths in 2011, increasing to 14,000 (13,000-15,000) in 2030. The Dutch Model demonstrated a 39% increase in the number of people with COPD in England and a 17% increase in Scotland between 2011 and 2030. It provided an estimate of a 30% increase in deaths among people with COPD in England and of a 43% increase in Scotland. Overall, there was a projected 46% increase in the direct healthcare costs required to care for people with COPD in England and a 23% increase in Scotland between 2011 and 2030. The reasons for these differences are largely due to higher COPD-related excess mortality in Scotland and to differences in the data used for populating the model in both countries. Conclusions There are likely to be substantial increases in the number of people with COPD, associated morbidity, direct healthcare costs and mortality in both England and Scotland over the next two decades. These increases in numbers will predominantly occur in females over 65 years of age and are likely to have substantial societal impact in terms of organising the health and social care for this frail population.

Orientador: Dionei Ramos / Banca: José Roberto Brito Jardim / Banca: Ercy Mara Cipulo Ramos / Resumo: Pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) apresentam comumente intolerância ao exercício físico de intensidade variável e relacionada à disfunção muscular esquelética. Assim, o exercício físico tornou-se importante no processo de reabilitação desses pacientes. Objetivo: avaliar a eficácia de um programa de treino resistido com corda elástica na força muscular periférica, capacidade funcional e qualidade de vida de pacientes com DPOC. Métodos: foram avaliados 34 pacientes (24 homens; 10 mulheres) com DPOC, idade de 62 ± 8,27 anos e IMC de 21,29 ± 3,73, alocados em dois grupos: treino resistido convencional e com corda elástica pelo período de oito semanas e frequência de três vezes semanais. As varáveis avaliadas foram força muscular periférica com dinamômetro, capacidade funcional pelo teste de caminhada de seis minutos e qualidade de vida pelo questionário Chronic Respiratory Questionnaire (CRQ). Resultados: a avaliação da força muscular periférica apresentou melhoras nos dois grupos estudados para todos os movimentos realizados durante o protocolo. O desempenho no TC6 (metros) apresentou melhora após oito semanas de treinamento, tanto no grupo corda elástica... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In general, patients with Chronic Obstructive Pulmonary Disease (COPD) patients have intolerance to exercise of variable intensity and related to skeletal muscle dysfunction. So, the exercise has become important in the process of rehabilitation. Objective: To evaluate the effectiveness of a program of resistance training with elastic band in peripheral muscle strength, functional capacity and quality of life of patients with COPD. Methods: We evaluated 34 patients (24 men, 10 women) with COPD, age 62 ± 8.27 years and BMI 21.29 ± 3.73 divided into two groups: conventional resistance training and with elastic band for the period of eight weeks and frequency of three times weekly. Peripheral muscle strength was assessed with a dynamometer, the functional capacity for the six-minute walking test and quality of life for the Chronic Respiratory Questionnaire (CRQ). Results: the assessment of peripheral muscle strength had improved in both groups for all muscle groups exercised during the protocol. Performance on the 6MWT (meters) showed improvement after eight weeks of training, both in the elastic band... (Complete abstract click electronic access below) / Mestre

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Rationale: The prevalence of obesity among individuals with chronic obstructive pulmonary disease (COPD) is increasing, which contributes to further ventilatory limitations, and compromised exercise capacity, and health-related quality of life (HRQOL) compared to COPD alone. Objective: To conduct a systematic review to evaluate the effects of exercise interventions on walking capacity, ventilatory parameters, anthropometrics and HRQOL in individuals with COPD and elevated weight. Methods: A search was conducted on March 16, 2018 of Embase, Medline, CINAHL, AMED and PsycINFO for controlled trials of exercise interventions, involving adults with any stage of severity and stability of COPD with concurrent obesity or overweight. Overall effects were determined with standardized (SMD) and weighted (WMD) mean difference, using Review Manager 5.3. Results: Nineteen studies with 1716 participants (BMI mean ± SD 28.2 ± 5.1 kg/m2) were included. Exercise interventions were effective in improving walking capacity measured by the 6-Minute Walk Test (6MWT), Endurance Shuttle Walk Test and Incremental Shuttle walk Test (12 studies, 1215 participants, SMD 0.25 (95% CI [0.06, 0.43]); p=0.01), fat-free mass index (2 studies, 285 participants, WMD 0.33 kg/m2 (95% CI [0.21, 0.46]); p<0.00001), St. George Respiratory Questionnaire (6 studies, 648 participants, WMD -7.49 points (95% CI [-13.01, -1.98]); p=0.008) and Chronic Respiratory Disease Questionnaire Dyspnea (5 studies, 478 participants, WMD 0.51 points (95% CI [0.00, 1.02]); p=0.05), Emotion (4 studies, 404 participants, WMD 0.28 points, 95% CI [0.03, 0.54]); p=0.03), and Mastery domains (4 studies, 404 participants, WMD 0.31 points (95% CI [0.02, 0.59]); p=0.03). There were no effects on ventilatory parameters or anthropometric measures. Conclusions: Exercise interventions were effective in improving walking capacity and HRQOL in individuals with COPD and elevated weight. There is an important opportunity to establish effective interventions to minimize the functional and health effects in this subset of the COPD population. / Thesis / Master of Health Sciences (MSc)

The study, using a quasi-experimental design, examined the relationship between participation in a comprehensive pulmonary rehabilitation program, locus of control, and the psychological and social concomitants of chronic obstructive pulmonary disease. The study investigated the following questions. To what degree participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component would: (1) generally produce a shift in persons from an external locus of control toward an internal locus of control, (2) specifically decrease the perception of chance, fate, or powerful others to influence and determine personal health; and (3) will result in the lessening of perceived negative effects of the psychological and social concomitants of chronic obstructive pulmonary disease. Two sample groups were evaluated in the study: (1) a group of 35 moderate to severe chronic obstructive pulmonary disease patients enrolled in a 96-hour comprehensive pulmonary rehabilitation program with a 32-hour psychosocial instructional component, and (2) a group of 35 moderate to severe chronic obstructive pulmonary disease patients receiving standard medical care at a Veterans Administration Hospital. Research instruments used for the study were the Multidimensional Health Locus of Control Scale and the Sickness Impact Profile. The research instruments were administered to each study group at approximately 16-week intervals. Results of the study indicated that participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component did not produce a significant shift in program participants from an external locus of control toward an internal locus of control, nor did it produce a significant decrease in the perception of chance, fate, or powerful others to influence and determine personal health. However, the study results indicated that participation in a comprehensive pulmonary rehabilitation program did produce a significant (P < .05) lessening of perceived negative physical and psychosocial effects of chronic obstructive pulmonary disease as measured by the physical scale, psychosocial scale, and total score of the Sickness Impact Profile.